| NPI | 1316485675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSEY GULLO Owner 904-719-3902 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL SW13172) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |